基于AGREE Ⅱ对糖尿病足预防与管理循证指南的评价研究

摘要

目的 评价糖尿病足预防与管理相关的最佳实践指南,为临床决策及我国临床实践指南的制定提供参考意见.方法 计算机检索加拿大安大略省注册护士协会、苏格兰院际指南协作网、英国国家卫生与临床优化研究所、新西兰校际指南协作网、美国国立指南网、国际指南协作网等循证指南数据库,根据纳入排除标准筛选公开发表的有关糖尿病足的临床实践指南.采用临床指南研究与评估系统对检索到的相关指南进行方法学质量评价,使用组内相关系数进行评价者间一致性检验,并进行各指南推荐意见的内容分析.结果 共纳入6部临床实践指南,指南总体质量评价为4个A级,2个B级.指南在6个领域的AGREE Ⅱ评价得分范围在70.83％ ～ 87.04％之间;6部指南的组内相关系数介于0.642 ～0.951.结论 纳入的糖尿病足临床实践指南总体质量较高,可以为我国糖尿病足预防与管理的临床实践指南的制定提供证据支持,但是将国外指南应用于我国临床环境之前必须经过严格的本土化过程.%Objective To evaluate the quality of evidence-based guidelines for diabetic foot prevention and management,in order to provide reference for decision-making and clinical practice.Methods To screen guidelines for prevention and management of diabetic foot by searching the databases such as Registered Nurses Association of Ontario (RNAO),Scottish Intercollegiate Guidelines Network (SIGN),National Institute for Health and Clinical Excellence (NICE),New Zealand Guidelines Group (NZGG),National Guideline Clearinghouse (NGC),Guideline Intemational Network (GIN),reviewed and assessed the guidelines by AGREE Ⅱ instrument and measured the overall agreement by the intragroup correlation coefficient (ICC).Results A total of 6 guidelines for prevention and management of diabetic foot were included,for general quality evaluation,4 guildlines were evaluated as level A,2 guildlines were evaluated as level B and the mean scores of 6 domains by AGREE Ⅱ were from 70.83％ to 87.04％.The ICC was from 0.642 to 0.951.Conclusion The quality of guidelines for prevention and management of diabetic foot are good in general.And they can offer the evidence support for clinical.However,before implement the guidelines,we must tailor and localize the content and recommendation of guidelines.